Even More Medical Myths

While it’s hard to be certain, it seems reasonable to assume that acute appendicitis has been around for a long time, certainly from before its recognition towards the end of the nineteenth century. The natural history of (untreated) acute appendicitis is equally uncertain, though one can guess that roughly a third of cases resolve spontaneously, one third progress to a local abscess (which may resolve, or rupture) and the last third burst, resulting in generalised peritonitis which,without treatment,is invariably fatal. 

The cause of acute appendicitis was greatly facilitated when King Edward VII underwent an operation on the eve of his coronation — but only after being told that if he didn’t have the operation he would go to his coronation in his coffin. Actually, the King had an appendicular abscess drained, and his appendix wasn’t removed, but this mere detail did nothing to prevent the rise of the procedure.

Because of the danger of generalised peritonitis, it was totally acceptable that around one-fifth of all removed appendices should be normal — better to remove the normal than let the inflamed burst.

With acute appendicitis established as a real and treatable disease, there was a slightly later invention of ‘grumbling’ or ‘chronic’ appendicitis. In this ‘condition’, patients with on-going bellyache, specifically in the lower right-hand part, appendicectomy was the ‘ideal’ operation. Even if the bellyache didn’t resolve, there was no longer the fear of acute appendicitis and generalised peritonitis. In any case, the appendix was clearly a ‘vestigial’ organ whose removal was only really hastening the change to be expected from evolution (though not by natural selection).

Like the ‘redundant prepuce’ and the appendix, the tonsils were clearly organs in need of extirpation. They enlarged during childhood, and this was clearly a ‘bad thing’. That their enlargement was normal and ‘necessary’ was a minor detail, easily ignored. And like the prepuce, no family was properly hygienic unless the tonsils of the offspring were removed, with the kids lined up, waiting for the guillotine. 

The prepuce, clitoris, uvula and tonsils are all easily accessible; what does that say about the ‘need’ for their removal?

Investigations progressed during the early twentieth century, and it’s no surprise to find that previously unknown diseases were uncovered. One of the best of these was nephroptosis, or sagging or droopy kidney. Patients would present with aches over a kidney, and investigation would show that the organ sagged when they stood up: post hoc, ergo propter hoc. At this time, anatomy was learnt on preserved cadavers placed supine, and the normal sag when people stood up wasn’t understood. 

While there might have been a few brave souls who denied the existence of nephroptosis, the most heated argument was between those who thought that the offending organ should be removed and those who thought it should be fixed in position. Even today, there is a residue of belief in nephroptosis — and the article in Wikipedia is utter rubbish.

The kidney wasn’t the only droopy organ; the caecum, that blind-ending part of the large bowel beside the appendix, was found to sag when people stood up. And, unsurprisingly, the argument was between the ‘fixers in place’ and the ‘loppers out’.